Powerlessness and social exclusion: an exploration of the women’s capabilities index for female sex workers in kampala, uganda.

Greco, Giulia (1,2); Katumba, Kenneth Roger (2); Seeley, Janet (1,2) (2019). 'Powerlessness and social exclusion: an exploration of the Women’s Capabilities Index for female sex workers in Kampala, Uganda.' Paper presented at the annual conference of the HDCA 2019, London, UK.


The Women’s Capabilities Index (WCI) is a multidimensional metrics based on Sen’s capability approach. It was developed for assessing the quality of life of women in rural Malawi (Greco et al. 2015). This study is part of a project that aims at adapting the Women’s Capabilities Index to a different context: women engaged in high-risk sexual behaviour in Kampala, Uganda. The process of adaptation of the measure includes an explorative phase for assessing the extent to which the list of capabilities generated for the Women’s Capabilities Index is valid in a different low-income setting (Uganda) and therefore with the scope to be more widely applicable. The list of capabilities in the WCI includes: physical strength, inner wellbeing, household wellbeing, community relations, and economic security. The specific objective of this study is to explore the capabilities, hopes and aspirations of women engaging in high-risk sexual behaviour in Kampala, Uganda.

To be consistent with Sen’s theory, the exploration of capabilities was conducted in a participatory manner using focus group discussions. The focus group discussions have two objectives: a) to explore locally relevant concepts of quality of life, dimensions of wellbeing, valuable beings and doings; and b) to explore the value and rank of the different concepts.

Information on the women’s perspectives on what constitute a good life, and their hopes and aspirations were collected with 10 focus groups, with 10 – 12 participants each. The participants were women attending the Good Health for Women sexual health clinic in Mengo, Kampala. Women minor of age were excluded. Two-stage randomised cluster sampling was used to select participants. Data collection took place from October to December 2017. Findings were elicited based on manual framework analysis. Framework analysis uses a thematic approach but allows themes to develop both from the research questions and from the narratives of the discussions.

Results suggest that women who engage in commercial sex in Kampala have diverse socio-economic backgrounds, but share a similar status of powerlessness, and lack of hope and aspirations for the future. Some women hold a university degree, many are illiterate. The majority are single mothers, and have been victims of violence perpetrated by clients, their partners, and in the past by their relatives and teachers. Many are the women who migrated from rural areas to the city, in search of waged labour, and often already in a position of disempowerment. They were brought into town with the promise of better opportunities for education, employment, or marriage. They might have started working as housemaids, but things did not go as planned: an unexpected pregnancy, a breakdown of a relationship, debts. Each have their unique life story and pathways to social exclusion. It emerged from this and other studies, that different pathways to prostitutions have in common a condition of powerlessness and gender inequity (Mbonye et al. 2012). It is particularly evident during negotiations for safer sex with a client, when the woman is often unable to protect herself from violence and HIV, as well as other diseases. Often, sex workers have to accept unprotected sex because of fear of violence, or because they are in desperate financial needs. For these women, a “good life” is having enough money to pay rent, feed their children, and pay school fees. Whatever hope they have, it is not for them, but for their children so that one day the children will be able to take care of them in return.

This study adds to the evidence provided by Marmot and others on how people with limited control over their lives are not able to make choices to keep themselves safe and healthy, and how ill-health, and gender inequality, are caused by material, psychosocial and political disempowerment. Empowerment, having real freedoms or choices, is a crucial determinant of health.

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